05090033 CITY OF CUPERTINO -
BUILDING DIVISION PERMIT CONTRAG'FORINFORMATION
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PBulEING ADDRESS: TAYLOR WOODROW HOMES PERMITND.05090033
10280 PARK GREEN LN if R2R
OWNER'S NAME: PERMIT MUE DATE
TAYLOR WOODROW HOMES 2300 CAMIN
E: SANITARY N, CONTROL NO
(925) 365-3100
fAIVIITEC(ENGINEER: BUILDING PERMIT INFO
BLDG ELECT PLUMB MECH
+oo LICENSED CONTRACTORS DECLARATION
C I lmmby affirm Nu I am li¢vN under provisions of Chapter 9(commencing lob Description
Z.
wiN&.do.7")of DMv on3ofNe BusinevaM oCcWons Code,andmyliccn.0
<n infullfoocandcffmtt REVISION-MOMENT FRAMS
;�_ uecn.0 r u.g Ka40 6 '6 /STEEL PLANS
=mac D.k �Co.truwr NO NEW PERMIT ISSUED/ORIG. #05030061
- ARCHTIEC`S DECLARATION
f w U I understand no,ph.Nall W used u public rtcards
G f, Licensed Professional
5 OWNER-BUILDER DECLARATION
gg I hereby aRrm Net I em exempt from the Contractor's License Law for the
p O following mason.(Section 7(U I.S,Business and Proftstinn Cade:Any city Or cony
i m which requires a permit in cnnuract.alms improve.demolish,or minor.y structure
�ato prior to its issuance.also mquions the applicant rot such permit in rile a signed statement
< mat he is licensed pursuant to the provision of the Camramr'sLiecneLaw(Chapter 9 Sq.Ft.Floor Area Valuatio 214
YFO (Commencing with Section 7000)of Division 3 of the Butinm and Nufmions Cute)or
y $
Out he m eumpt merefrum and the basis fm the alleged exemption.Any violation of
Section 703 L5 by any applicant for a permit subjem the applicant in a Civil penalty of APN Number Occupancy Type
tot mom dun rise hundred dollars(55001. 36940017 . 00
p y yp
C L u oweor of the property,Or my employees wash wages u mail=In Compensation,
will do dw work,and me structure u os intended car Bound for sale(Sm.7144.Business
and Profession Code:The Contactors License Law docs an,apply to an Ownv of Required Inspections
property who builds teire proves themon,and who dos such work himself or Omagh his
own employcem.uninvited mat such improvements tie not intended oroBered for We.B,
however,On Wilding or improvement is sold within one year of cnleplcdon.me owner-
builder will have the burden of Proving mut he did not Wild or improve for purpose of
sal..).
C 1,u..r of the property am exclusively Contracting with licensed Cnnuacws in
onwct me,project(Sec.7044.Business and limitations Code)The Cosracmrs U.
cause Law does nos apply in an owner a propvsywW Wilds or imposm thereon.and.
who contracts for such project wim a contractor(s)licensed pursuant to the Com tactors
LicMan Law.
C lamesemptunder See ,Bd1PCformmmason
Owner Date
WORKER'S COMPENSATION DECLARATION
1 hereby afrusv under penalty of perjury arm of cit following declaration:
7c,
haw and will maintain a Cmdficateof Convent m self-insure fm Wounces C.N..
n,u provided fm by Section 3700 of rite Labor Cade,for me performance of the
for which this permit is issued.
have and will maintain Worters Compensation Insurance,u required by Beetles
ar me,Labor Code,for me performance Often work for which this Permit issued. '
Worker'Sotppc o Norut¢carrier and Policy number am:
ee e\ I�f�_PolicyNa.: Dh'79oSa
�i �C I ATEO EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE
from sanion need Out bocomplemd lime permit is throne hundred dollars nt(al)
or less)
I Cudfy mat in me perfnnumen of the work for wbich mil Permit is issued.I Nall not
employ any person in any manner.u to become sobject to me Wodrcrecompcuation
Laws of ciddlomia Dau
Appliwn
NOTICE TO APPLICANT:IL after making mu Oeruriote or Exemption,you should
become subject in me worker's compensation provision of me Labor Code yen mut
.J z roMwith Comply with Men Provision or this permit shall be deemed rooked.
ZC7 CONSTRUCTION LENDING AGENCY
[--� Ihereby affirm that more is a construction lending agency for me performance of
D4 s7 me work fur which this permit m issued(Sec.3097.Civ.C.)
C 0 Latrines Name
=z lenders Address
V Q 1 Certify Nat 1 have mad this application and suis dor the also.information is
gL CaneR I agree to Comply with all city and County con.and stat law;reading to
0 V Wilding construction,and hereby authorize rtpreseaudves of this city in enter upon th
p.rp
shoved.j.dS. propertyfor inspection which a
F LL (We).gone maw,indolently and kap harmless the City of Cupertino againu
fn in
of theouandofpe;nscsmit. they in any way acme against said City
(�2 in conuquene of the granting of Nu permit.
^ APPLICANT UNDERSTANDS AND WILL COMPLY WITH ALL NON-POINT Issued by: do Date
SOURCE REGUL ONS.
Re-roofs
Signuumn( pplicandCotacmr Date
HAZARDOUS MATERIALS DISCLOSURE Type of Roof
Will the applicant or future Wilding Occupant sum mhandro harudous maminl
u defined by cot Cupertino Municipal Cods.Chapter 9.13,and the Health and Safety,
ask.Sectio 25533(x)?
❑Yes -gall All roofs shall be inspected prior to any roofing material being installed.
Will the appric.t Or future Wilding Occupant nso equipment or dcvim which If a roof is installed without first obtaining an inspection,I agree to remove
tmit hvardnos air camsminanes u defined by the Bay Area Air Quality Management all new materials for inspection.
District]
CY. ONO
I have mad the ha vdau materials onquiremeor under Chapurb.95ofdm Glifor.
nix Head"SafmyCo t.Sa'dom 25505,25533 and M2tl.1 understand mrtifmc Wilding
dor of curemly haw a rerun mu it u my responsibility m edify,me Occup tit of me
rcya+mme^I,,I to be met nano ar,cwec,�g Signature of Applicant Date
Owner or/umoficd agent / paje' All roof coverings to be Class nBn or better